Lung-sparing surgery in combination with photodynamic therapy (PDT) improved overall survival in patients with pleural mesothelioma compared with patients treated with conventional therapy of extrapleural pneumonectomy (en bloc removal of the lung and surrounding tissue) plus PDT.

Mesothelioma is usually caused by exposure to asbestos. Although the cancer may not develop for up to 50 years postexposure, the average survival rate following diagnosis often is only 9 to 12 months. The most common form, pleural mesothelioma, originates in the membrane surrounding the lung and lining the chest. Because surgery alone does not remove the cancer, which has a coating and enveloping nature, the conventional surgery-based approach to treatment involves removing the lung and administering chemotherapy and whole-chest radiation, but the disease recurs in almost all patients nonetheless. The PDT used in the current study penetrates only a short distance, preserving the lung,

In the small, 4-year project, 28 people (mean age 27 to 81 years) with malignant pleural mesothelioma underwent macroscopic complete resection using one of two surgical techniques: modified extrapleural pneumonectomy (MEPP; 14 patients) or radical pleurectomy (RP; 14 patients). Of the final 16 patients, 13 underwent lung-sparing procedures, even in the setting of large-bulk tumors. Twenty-two patients also received chemotherapy.

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Median overall survival for the MEPP group was 8.4 months. However, for the RP group, overall survival had not yet been reached by a median follow-up of 2.1 years after the end of treatment.

Although all patients in both groups received PDT plus a different surgical technique, the researchers noted that use of the intraoperative PDT is the evident difference between the multimodal protocol used in the current study and other standard treatment options.

“Given these results, we believe RP plus PDT is a reasonable option for appropriate patients pursuing a surgical treatment for malignant pleural mesothelioma and that this procedure can serve as the backbone of surgically based multimodal treatments,” concluded a research team led by thoracic surgeon Joseph S. Friedberg, MD—codirector of the Penn Mesothelioma and Pleural Program at the Raymond and Ruth Perelman School of Medicine at the University of Pennsylvania in Philadelphia—in The Annals of Thoracic Surgery (2011;91:1738-1745).